11070031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11234 MT CREST PL CONTRACTOR:COSMOS ROOFING PERMIT NO: 11070031
OWNER'S NAME: SASAKI GARY AND SHAUN 1901 OLD MIDDLEFIELD WAY STE DATE ISSUED:07/06/2011
OWNER'S PHONE: 4089812288 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663
YA LICENSED CONTRACTOR'S DECLARATION F– F_
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class G Lic.# ? S5 +41 f— f— (—
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby a irm th m li d under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 30 SQ-TEAR OFF AND INSTALL TAR&GRAVEL
CLASS A
(commenci ith Seeti6n 7000)of Division 3 of the Business&Professions
Code andrity icense is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$13625
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
APN'.Number:35626013.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above inf mation PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws r lating WLLTI SOF PERMIT ISSUANCE OR
E
to building construction,and hereby authorize representatives of this city to enter P
upon the above mentioned property for inspection purposes. (We)agree to save 180 D LAST CXLLED INSPECTIO
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 71611 All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
WNER-BUILDER DECLARATION / ,
Signature of Applicant Date: (�
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL RO RINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS.MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I C 064 STR LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
ing of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cupertino.org
PROJECT ADDRESSI4 T.
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APN#
OWNER NAME / \ C PHO N O 1-2-sE-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
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CONTRACTOR NAME LICENSE I R LICENSE TeE BUS.LIC.#
COMPANY NAME `1v ' r✓ r E-MAILAJ�C' � �'
STREET RESS (�J�- Y,STATE,ZIP �, PHSONE
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'cjcI UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00— 3:30pm(Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofing which is applied without first obtaining an approved inspection
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of'/4"per foot of slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will
be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the follow'
e: I am the property owner or authorized agent to act
on the property owner's behalf. I underst nd agree t comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date:
ReroofPolicy_201 0.doc revised 05/17/10
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35626013 . 00
DATE ISSUED. . . . . . . : 07/06/2011
RECEIPT # . . . . . . . . . BS000013973
REFERENCE ID # . . . : 11070031
SITE ADDRESS . . . . . : 11234 MT CREST PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER SASAKI GARY AND SHAUN
ADDRESS . . . . . . . . . . : 11234 MT CREST PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4750
RECEIVED FROM . . . . : PERMIT SERVICES
CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844
COMPANY . . . . . . . . . . : COSMOS ROOFING
ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WAY STE 2
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 969-7663
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13 , 625 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 13 , 625 . 00 1 . 36 0 . 00 1 . 36 0 . 00
1REROOFRES SQ FEET 30 . 00 420 . 00 0 . 00 420 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 422 . 36 0 . 00 422 . 36 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 422 . 36 2539
---------------
TOTAL RECEIPT 422 . 36
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF